By Anne King
Recently I visited with some experts at the Hospital for Sick Children in Toronto (SickKids), for a discussion about food allergies and mental health. Dr. Melissa Lieberman is a Psychologist in the hospital’s Eating Disorders Program and Kellie Welch is Clinical Dietitian, also at SickKids. We discussed the challenges facing parents and the issues that can arise as children grow up and attain independence.
This first question is about young children such as toddlers and preschoolers. If allergens are present (school, stores, family gatherings) how can parents reassure and empower their children so they can be safe but not afraid?
Dr. Lieberman: There needs to be a very careful balance. Young children will feel less anxious if they know that the adults in their lives can manage their allergies and keep them safe. Parents should speak to their children about their allergies in a calm way, using developmentally appropriate language. It is important that parents do not scare their kids but rather reassure them that they have an allergy and it can be dangerous, but if they are prepared (for example, by carrying their auto-injector), they will be okay.
Parents should also focus on building their own confidence and competence in relation to their child’s allergies, in order to avoid passing their worries on to their child. A child who is anxious by nature may need more coaching and reassurance. If parents are unsure about how to talk to their child about allergies, they should speak to a professional.
As a psychologist, have you worked with a young person impacted by food allergy anxiety? How do you respond and treat it?
Dr. Lieberman: I have worked with young people who have developed serious eating disorders due to fears of allergic reactions to food. Anxious children with food allergies can narrow their food choices to the extreme, leading to weight loss and other issues. Avoidant/Restrictive Food Intake Disorder, also known as ARFID, is a new eating disorder that was introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Treatment involves Cognitive Behaviour Therapy (CBT), working with both the parents and the child. This evidence-based treatment is used widely for children with anxiety disorders. We have found this treatment to be very effective in working with children who have been diagnosed with ARFID.
Some parents may need additional support to deal with their own anxieties about their child’s condition as well. Online and in person support groups can be a great resource for parents.
In the days after a serious food allergy reaction, there can often be a lot of anxiety throughout the family. What are your thoughts on how to get back to healthy eating and over the hurdle of the experience?
Dr. Lieberman: It is natural for kids to be anxious after a serious allergic reaction. If a reaction occurs, it would be important for parents to have an open discussion with their child about their fears and worries. Parents can reassure their child as much as possible by reminding them that food allergies can be managed. If the anxiety does not subside over time, children can also see a therapist to learn effective coping strategies.
Following an allergic reaction, parents should model positive coping for their children. Children need their parents to be empathetic listeners, and to provide them with reliable and unconditional support. Sometimes, though, parents feel anxiety, guilt and self-blame following an allergic reaction. It is important to remember that mistakes can happen. Parents often find it helpful to share their stories with other parents who have children with similar allergies.
What if a child is a picky eater in addition to having food allergies? I know in my own family this was a tricky one.
Kellie Welch, RD: It can be frustrating or worrisome when children are picky eaters, particularly if they have food allergies as well. According to Ellyn Satter, parents and children have different jobs for feeding. A parent’s job is to decide what food and drinks are offered, when food is offered and where food is offered. Your child’s job is to decide if and how much to eat from the food and drinks you have served.
It’s best to keep mealtimes pleasant and stress-free. Try to avoid pressure, praise, rewards, tricks or punishment. Children do not eat well when they are pressured in these ways.
With food allergies, sometimes parents err on the side of caution and avoid other common food allergens. However, when a child’s diet is already restricted due to food allergies, it is important to avoid limiting it further out of fear. Parents should work closely with their allergist and dietitian. Once you have the information you need, don’t be afraid to experiment with new foods, and be persistent. Offer a variety of foods and offer each food multiple times before you give up on it. Integrate a new food with something your child is familiar with.
Are there dietitians who specialize in food allergy?
Kellie Welch, RD: Dietitians of Canada is an excellent resource to find a dietitian who specializes in treating children with food allergies. EatRight Ontario allows you to ask nutrition-related questions and receive feedback by phone or email from a Registered Dietitian. The Specialty Food Shop serves the needs of unique patient populations such as those with food allergies, celiac disease, dysphagia, energy boosting needs, metabolic disorders, cystic fibrosis and patients requiring assistive feeding devices.
These are great resources. I’m always impressed by how parents find and makes use of resources, then team up with their kids to make it all work.
Dr. Lieberman: Having a food allergy is just one part of who children are. It should not stop them from having a happy childhood and a full life.
Absolutely. Thank you both, very much.
Resources
- Food Allergy Canada’s Newly Diagnosed Support Centre offers advice and insight on all aspects of managing food allergies, for parents of newly-diagnosed children.
- Dietiticians of Canada has a resource list of dietitians with specializations.
- The Specialty Food Shop at SickKids. Shop online or in store for specialty foods.
- Eat Right Ontario Online access to dietitians.
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Tags: Anxiety, ARFID, Dr. Melissa Lieberman, eating disorder, Kellie Welch, mental health, RD, SickKids